Provider Demographics
NPI:1477295244
Name:JOHNSTON, CRAIG TYRRELL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:TYRRELL
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 W 36TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506-3565
Mailing Address - Country:US
Mailing Address - Phone:814-490-6351
Mailing Address - Fax:
Practice Address - Street 1:311 W 24TH ST STE 305
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2666
Practice Address - Country:US
Practice Address - Phone:814-454-4484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT021452390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program